Understanding 0bsessive Compulsive Disorder in Children

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Most of us are familiar with obsessive compulsive disorder in adults, yet OCD is one of the most common disorders in children and adolescents, with estimates ranging from 1-2 percent of children in the U.S., according to the American Academy of Family Physicians.

Obsessive compulsive disorder is characterized by intrusive thoughts known as obsessions and repetitive behaviors known as compulsions, according to the American Academy of Child and Adolescent Psychiatry. They define obsessions as “recurrent and persistent thoughts, impulses or images that are unwanted and cause marked anxiety or distress.”

Because of the time, attention and energy children expend on the disorder, their daily life is negatively affected, says Rebecca R. Jackson, executive director of Brain Balance Achievement Centers in Cary and Chapel Hill. They’re late for school and often experience struggles there, and may miss important play opportunities with friends. Lengthy rituals and intrusive thoughts keep them from sleeping well. Their obsessive thoughts dominate everything, to the point they aren’t able to think or talk about anything else.

“If they don’t act, they’re sure the results may be catastrophic,” Jackson says. Children and their parents end up stressed out, frustrated and upset.

An OCD diagnosis is made when the obsessions and compulsions cause significant stress and anxiety, as well as interfere with a child’s daily life, social activities, academics or relationships, says Kevin L. Gyoerkoe, psychologist and director of the Anxiety and OCD Treatment Center in Charlotte.

Child-Onset OCD

One-third of adults with OCD developed their symptoms when they were children, according to the International OCD Foundation. OCD symptoms manifest in much the same way for both children and adults.

In children, however, the specific thoughts and actions are typically age-appropriate. A child might have intrusive, anxiety-provoking thoughts about harm befalling his parents or siblings, Gyoerkoe says. She might feel intense anxiety if all of his or her toys aren’t lined up in one direction. Children often report needing to do things a certain way because everything must be “just right” or they feel anxious and stressed.

“One of the most significant differences between OCD in adults versus children is the level of self-awareness,” Jackson says. ”A child will have a hard time recognizing that the worry or action is beyond what’s acceptable. They simply have something on their mind that won’t go away.”

“The age of the child doesn’t affect the prognosis or hinder treatment,” Gyoerkoe says. However, the type of OCD — the specific thoughts and compulsions — will likely change as the child grows and matures. Research suggests child-onset OCD is also sensitive to environmental factors, with symptoms increasing during stressful events, according to a 2011 review published in the Dialogues in Clinical Neuroscience Journal.

Common Obsessions and Compulsions

The incessant thoughts children struggle with may include excessive concern over germs, diseases and illness. One child has irrational fears that he may accidentally or purposefully hurt others, such as causing a car crash. Another is convinced he didn’t do a chore correctly or finish his homework, even though he did.

To cope with this anxiety, a child develops rituals — activities or behaviors she must repeat over and over. She has to wash her hands until they’re chapped and reddened. She brushes her teeth until her gums bleed. She may check that the doors are locked numerous times or need to have her socks at the exact same height. She needs to redo a task or chore repeatedly until it “feels right.”

According to the International OCD Foundation, other common compulsions include erasing and rewriting, asking the same question over and over, confessing or apologizing, checking and rechecking, tapping, counting, ordering, arranging and hoarding.

Cause and Effect

The causes of OCD aren’t known; however, a 2014 study published in the Journal of the American Medical Association revealed that OCD has a genetic component. Another 2014 study, published in the Psychiatric Clinics of North America Journal, found that if a close family member has OCD, the genetic risk that a child will inherit the disorder is 20-25 percent.

However, genetics only explain part of the story, Gyoerkoe says. OCD can be triggered by environmental factors, such as a strep infection or stressful life event.

Jackson concurs that environmental considerations are now being factored into the equation. “OCD, like many things, can be a combination of our genetics as well as how the environment and our development impacts those genetics,” she explains. “Researchers have only recently shifted their focus to epigenetics, which looks at how our environment impacts the expression of our genes.”


Child-onset OCD can be managed successfully with treatment. “Medication, behavior strategies and addressing the underlying area of concern in the brain are all treatment options,” Jackson says.

“The gold standard of treatment for OCD in children is cognitive-behavioral therapy, focusing on exposure and response prevention,” Gyoerkoe says. CBT is supported by numerous scientific studies and recommended by the Mayo Clinic, the National Institutes of Health, Harvard University Medical School and the American Academy of Child and Adolescent Psychiatry.

CBT therapy works to “retrain” the brain. The child learns behavior strategies to address and minimize their thoughts and compulsions. An experienced therapist works with the child and his or her family to develop a diagnosis and recommend a treatment plan. In addition, the American Academy of Child and Adolescent Psychiatry recommends medications such as serotonin reuptake inhibitors to help manage symptoms if therapy alone isn’t enough.

What Parents Can Do

If you’re worried your child might have OCD, schedule a consultation with a psychologist who specializes in the treatment of OCD, preferably one who is experienced with children. Gyoerkoe recommends that parents search for specialists in their area through the International OCD Foundation at iocdf.org or the Anxiety and Depression Association of America at adaa.org.

“While you may be able to control your thoughts and actions, your OCD child cannot,” Jackson says. “Know that this is outside of their control, and love them through it all.”

OCD and Strep Throat

A 2012 study published in the Pediatrics & Therapeutics journal suggests that a certain type of OCD may be related to strep infections, known as PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcus) or more recently, PANS (pediatric acute-onset neuropsychiatric syndrome.

“Children with PANS OCD experience a sudden onset of severe OCD symptoms like separation anxiety, extreme irritability, and neurological symptoms such as difficulty writing or memory loss,” says Kevin L. Gyoerkoe, psychologist and director of the Anxiety and OCD Treatment Center in Charlotte.

According to the National Institute of Mental Health, antibody formation may trigger an inflammatory reaction. Strep-triggered antibodies mistakenly attack specific brain circuitry, resulting in obsessional thoughts and compulsive behaviors.

“Increased inflammation has the potential to interfere with healthy function,” says Rebecca R. Jackson, executive director of Brain Balance Achievement Centers in Cary and Chapel Hill.

Kyla Steinkraus is the author of 25 children’s books. She loves reading, photography, and board games. Learn more about her at KylaSteinkraus.com.